Section 127.125. ASCs

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Payments to providers of outpatient surgery in an ASC, shall be based on the ASC payment groups defined by HCFA, and shall include the Medicare list of covered services and related classifications in these groups. This payment amount shall be multiplied by 113%. For surgical procedures not included in the Medicare list of covered services, payments shall be based on 80% of the usual and customary charge.

Notation

Cross References

This section cited in 34 Pa. Code § 127.101 (relating to medical fee caps—Medicare); and 34 Pa. Code § 127.159 (relating to medical fee updates on and after January 1, 1995—ASCs).

                    
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